As we move closer to campaign season and closer to changing some of the elements in the Vermont health care system it is important to separate political posturing from fact. It is also important to provide context for proposals. Single payer is not the solution to the currently broken health care non-system, it is one piece of a very complex puzzle.
Single payer only refers to how health care is financed, which means that it is an alternative to the current health insurance system. As the name implies, there is only one entity paying the bills and in the Vermont plan that will be the state of Vermont. It also means that Vermonters will no longer have to be controlled by the rules of insurance companies.
The state will set the rules for insurance and that means that the Green Mountain Care Board, the legislature and citizens will have an opportunity to be part of the process that sets those rules. We will no longer have to pass laws to protect us from the insurance companies.
In Vermont, there is a good chance that one insurance company, most likely Blue Cross Blue Shield of Vermont, will be contracted to handle the administration of the new single payer plan. The state will hire them for their expertise, but BCBS will no longer have to assume risk for insurance products. BCBS will have to abide by the rules determined by the state.
When you hear the worn out cry that "I don't want the government interfering with my health care,"
Also keep in mind that because single payer is only a financing mechanism it has little to do with the delivery of health care and the rest of the broken health care system. Reimbursement is one of the broken pieces so, unless the state of Vermont figures out a way to fund health care and pay providers at least 100 percent of what it costs them to provide care, reform efforts could fall apart.
It all comes down to money and politics in the world of health care reform. Many studies have been done and they all indicate that if we continue to pay the same amount of money we now pay for health care but change to a single payer financing system, eventually, everyone is better off.
The problem is that some people benefit sooner than others and some of the benefits may take decades to realize. Single payer will cut administrative expenses by about 50 percent. Estimates indicate that a Vermonter earning $75,000 or less would pay less than they pay now for health care whether a new system is funded by an income or a payroll tax. New dedicated taxes for health care would be needed, but it would mean that monthly premiums would be eliminated.
Even if Vermont moves to a single payer system we will still have to find a way to decrease the cost of the health care services we provide. This is the most difficult challenge we face because it means that we all have to have a stake in this process. It means that we have to work hard at preventing diseases before they happen as well as better managing the diseases we now deal with.
The reality of cutting costs may mean that the cost of health care does not decrease but that the percentage of yearly increase diminishes.
The Vermont Blueprint for Health, a national model for managing chronic diseases, is a start and people involved in the program understand the potential it has for decreasing the cost of health care while keeping people healthier. But we have to have a statewide education campaign to deal with obesity and all of the chronic diseases that Vermonters struggle with. Until eating healthy and exercising regularly becomes the norm, we will never make much progress.
The current health care system puts too much of the financial burden of the entire health care system on providers. They get hammered from the insurance companies who hold them in some sort of hostage state and federal and state governments make them subsidize care when government really can't afford to pay for it.
Providers should share some of the responsibility for keeping costs down but not in the way they are required to do so today. If we continue to pay them less than it costs to provide care while maintaining quality, a breaking point will come in the near future.
All of the reform measures in the world, including single payer, will mean nothing if government officials and policymakers do not set fair reimbursement as their highest priority. If they do that everything will move forward. If not, who knows what we will end up with?
Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at firstname.lastname@example.org.